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MRSA FAQs

Here are some basic facts about MRSA, what it is, what it isn't
and how you can help us to combat MRSA in hospitals

Question 1: What is Staphylococcus aureus?

Staphylococcus aureus is a bacterium that is commonly found on
human skin and mucosa (lining of mouth, nose etc). The bacterium
lives completely harmlessly on the skin and in the nose of about
one third of normal healthy people. This is called colonisation or
carriage. Staphylococcus aureus can cause actual infection and
disease, particularly if there is an opportunity for the bacteria
to enter the body eg via a cut or an abrasion.

Question 2: What illnesses are caused by Staphylococcus aureus?

Staphylococcus aureus causes abscesses, boils, and it can infect
wounds -- both accidental wounds such as grazes and deliberate
wounds such as those made when inserting an intravenous drip or
during surgery. These are called local infections. It may then
spread further into the body and cause serious infections such as
bacteraemia (blood poisoning). Staphylococcus aureus can also cause
food poisoning.

Question 3: How is Staphylococcus aureus infection treated?

Infections caused by many antibiotic-sensitive varieties of
Staphylococcus aureus are usually successfully treated with
antibiotics such as some types of penicillin and erythromycin. Some
S. aureus bacteria are resistant to the antibiotic methicillin, and
they are termed methicillin-resistant Staphylococcus aureus (MRSA).
They tend to be more complicated to treat and require the use of
other antibiotics. We are lucky in the UK that the MRSA that infect
patients are usually more sensitive to antibiotics than in some
other parts of the world.

Question 4: What is MRSA?

MRSA stands for methicillin-resistant Staphylococcus aureus.
They are varieties of Staphylococcus aureus that are resistant to
methicillin (a type of penicillin) and usually to some of the other
antibiotics that are normally used to treat Staphylococcus aureus
infections. There are different types of MRSA and the Health
Protection Agency is able to carry out laboratory testing to
distinguish between them.

Question 5: Is MRSA treatable?

It is not generally necessary to treat MRSA colonisation or
carriage. MRSA infection is no more dangerous or virulent than
infection with other varieties of Staphylococcus aureus , but it is
more difficult to treat depending on whether it is resistant to any
other antibiotics. Some of the antibiotics used to treat MRSA
however can on occasion be more difficult to use or may cause side
effects.

Question 6: Who is at risk of MRSA infection?

MRSA infections usually occur in hospitals and in particular to
vulnerable or debilitated patients, such as patients in intensive
care units, and on surgical wards. Some nursing homes have
experienced problems with MRSA. MRSA does not normally affect
hospital staff or family members (unless they are suffering from a
severe skin condition or debilitating disease). In general, healthy
people are at a low risk of infection with MRSA.

Question 7: What is the prevalence of MRSA in the UK?

MRSA are one of the most prevalent
micro-organisms involved with healthcare-associated infections
worldwide. Most patients who are colonized with MRSA do not go on
to develop an infection. The surveillance of MRSA in the UK is a
mandatory scheme run by the Department of Health and measures the
number of blood-stream infections reported by Acute NHS Trusts. The
latest data for this shows there were 3,517 reports between October
2005 and March 2006 (for further information see the mandatory
surveillance report 2006).

MRSA strains were first seen in many countries
in the 1960s, but new strains appeared in the 1980s, which have
caused outbreaks of infection in hospitals throughout the world
including the UK. Further new strains also emerged during the
1990s.

Question 8: What is the cause of the rise in MRSA infections in the UK?

The rise in MRSA infections in the UK is
likely to be multi-factorial. The new strains that emerged in the
1990s may be more virulent (i.e. more likely to cause infections)
than some of their predecessors, or more easily spread on the hands
of healthcare workers, equipment, and perhaps via the environment.
There are also a number of factors that aid in the spread of MRSA
in hospitals such as: patient transfers within and between
hospitals, the increasing number of very ill patients seen in
hospital and the difficulty in isolating some patients with MRSA.
The increasing complexity of healthcare and medical intervention
also add to the risk of acquiring MRSA.

Several studies have shown that workloads are
also an important factor: the more the required number of hand
hygiene measures needed per hour the less the compliance. This is
why rapid acting alcohol and other hand hygiene solutions are now
advocated in healthcare: they are easier and faster to use.

Question 9: How is MRSA spread?

MRSA is most commonly spread via hands, equipment, and sometimes
the environment. It is important that healthcare workers and
visitors wash their hands before and after visiting a patient.
Provided hands are not soiled (when they should be washed with soap
and water), rapid acting alcohol and other hand hygiene solutions
are now advocated in healthcare: they are easier and faster to use
than hand washing. Equipment should also be cleaned after use.

Question 10: What happens if I get an MRSA infection?

There will be precautions put into place to prevent the spread
of the organism from patient to patient. Ways of limiting the
spread include hand washing, cleaning equipment after use and
keeping the environment clean. The hospital may need to move the
patient into a single room, or in with other affected patients, to
reduce the risk of spread to another patient. Each hospital will
have a policy on how to best manage MRSA within their local
environment.

Question 11: Can a patient with MRSA have visitors?

Hospital strains of MRSA do not normally cause harm to healthy
people, including pregnant women, children and babies. Visitors
should ensure they wash their hands before and after visiting the
patient.

Question 12: How do you measure MRSA bacteraemia rates?

Some people carry MRSA most commonly in the nose and
occasionally on the skin without it causing harm to themselves or
others. This is known as colonisation or carriage. When a person
has an MRSA bacteraemia (bloodstream infection) this means that
MRSA has gained access to tissues and bloodstream and is
multiplying and causing harm. MRSA rates are measured by dividing
the number of patients with MRSA isolated from blood specimens in a
hospital by the activity level within the hospital which provides a
'rate'. This enables one hospital to gauge itself against other
similar hospitals and investigate possible causes for
differences.

Question 13: Is there any value in screening new patients to ensure they are not bringing MRSA into the hospital with them?

Carriage of MRSA should not be a reason for stopping admission
to hospitals, nursing or residential homes or for discharge to
their home. However sometimes hospitals screen upon admission eg
for planned elective surgery. This enables treatment eg special
washes or ointments to be given to reduce or clear MRSA before
surgery.

Question 14: Can MRSA be passed on by cleaning teams?

If equipment and wards are not cleaned properly there is a
possibility of a contaminated environment contributing to the
spread of infection. However dirty areas of hospitals do not
necessarily have high MRSA rates or, clean ones low MRSA rates.

Good hygiene particularly in the form of simple everyday
precautions such as hand washing is an effective method in the
prevention of MRSA spread. If cutlery and plates are washed using
soap and water (preferably hot) this will remove MRSA. The risk of
acquiring MRSA through contact with curtains, sheets and cushions
etc is very low.

Question 16: What decontamination methods can be used on people, wards, clothing etc?

Thorough hand washing and drying between caring for people, and
whenever necessary, has been shown to be the single most important
measure in reducing cross-infection. Healthcare workers use
antiseptic solutions, including alcohol hand rubs. More recently,
many hospitals have alcohol gels for hand cleaning at the end of
patients' beds. The environment must be kept clean and dry. Whilst
in hospital, patients may have to be nursed in a special ward and
visitors may be asked to wear gloves and aprons. Before going home
visitors may be advised to wash their hands.

Question 17: What research is being done to find better ways of protecting against the spread of MRSA?

Various research initiatives are underway from the design of
hospital wards, the use of isolation rooms, to the effectiveness of
interventions like Clean Your Hands Campaign and investigation of
the causes of multi-drug resistance. The Department of Health has
also set aside £3 million for research as part of implementing
Winning Ways, the Chief Medical Officer's action plan to reduce
healthcare associated infections.

Question 18: What is community-acquired MRSA?

Community-acquired MRSA infection (C-MRSA) is when an MRSA
infection occurs in a previously healthy individual who has no
recognised risk factors associated with MRSA - for example, no
previous hospitalisation, surgical procedures or prolonged
antibiotic treatment. In the UK, the term community-acquired MRSA
may refer to infections in residential homes caused by hospital
strains of MRSA However, some other countries (eg United States)
are describing strains of MRSA that have arisen in the community
('true' community MRSA) and are very different from hospital MRSA
strains. Some of these strains carry a toxin called
Panton-Valentine Leukocidin (PVL). These usually affect otherwise
healthy people and are unusual in the UK.

Question 19: Is C-MRSA a different infection than Hospital acquired MRSA?

Yes, 'true' C-MRSA infections are different from the hospital
acquired MRSA, notably C-MRSA is more sensitive to antibiotic
treatment than hospital acquired MRSA, and therefore a wider range
of antibiotics can be used to treat them.

Question 20: How common is C-MRSA in the UK?

There have been no systematic studies to establish how common
C-MRSA infection is in the UK , but S. aureus isolates referred to
the HPA's reference laboratory are routinely tested to identify
whether they are C-MRSA. Through this surveillance of MRSA
isolates, the Health Protection Agency has identified approximately
100 cases over the last three years.

Question 21: Who is more at risk of contracting C-MRSA?

It is believed that personal contact is the principal risk
factor, particularly where the skin is likely to be broken.
Investigations in countries that have seen this type of MRSA
describe infections in for example in prison inmates, those
involved in close contact sporting activities, the gay community,
and injecting drug users.

Question 22: How is C-MRSA treated?

Treatment of C-MRSA infection is easier than for hospital
acquired MRSA as C-MRSA are more susceptible to antibiotic
treatment. C-MRSA is universally sensitive to the antibiotics
vancomycin, rifampicin, gentamicin, and linezolid.

Question 23: How many people die from methicillin-resistant Staphylococcus aureus (MRSA) infection each year?

The Office for National Statistics (ONS) provides national
statistics on causes of deaths. ONS statistics show that in 2004 in
England and Wales, 1168 death certificates mentioned MRSA as a
factor contributing to the death of those individuals. In 360 of
these individuals MRSA recorded as the main cause of death, in
other words a death due to MRSA infection.

Question 24: Where does the figure of 5000 deaths due to MRSA each year come from?

This figure is incorrect. It comes from a very rough estimate of
the number of deaths which may be attributed to all hospital
acquired infections (HAI), not just MRSA. The estimate was made in
1995 by a working group of the Public Health Laboratory Health
Service. It used an estimate of the percentage of deaths associated
with all HAIs made in the USA in the 1980s (1% of all deaths in the
USA). This percentage was applied to the total number of deaths
occurring in the UK, yielding a crude estimate of 5,000 deaths from
HAI.

Question 25: What factors increase the risk of death in patients with MRSA infection?

Patients in hospital are more vulnerable to many infections,
including those caused by MRSA, because devices such as intravenous
catheters, or procedures such as surgery, provide an entry point
for germs to enter the body. The most common types of infection
caused by MRSA are local infections of the skin that can be treated
successfully with proper skin care and antibiotics. Some MRSA
infections can become life-threatening. Patients who are at
particular risk are those who are seriously ill with another
medical condition or whose immune system is weakened by diseases
such as diabetes or kidney disease, or by treatments for conditions
such as cancer.